the white count is raised, usually > 30 x 10^9 / litre, commonly, 100-250 x 10^9 / litre
differential:
the myeloid series is left-shifted with mature forms dominating
granulocytes especially neutrophils and myelocytes, greatly increased
basophilia and eosinophilia is common (1)
low percentage of blasts
red cells - anaemia in later stages, normocytic, normochromic
platelets - often normal, may be increased or decreased
bone marrow:
hypercellular with prominent granulocytic hyperplasia
megakaryocytic numbers often raised
high proportion of blasts suggests transformation
trephine biopsy - useful to assess degree of fibrosis and loss of marrow fat spaces
Philadelphia chromosome - often detected in peripheral blood or bone marrow
neutrophil alkaline phosphatase score is low providing evidence of qualitative abnormalities in neutrophils
serum vitamin B12 is high due to increased secretion of transcobalamin III
serum uric acid and alkaline phosphatase - often raised
Reference:
Smith G, Apperley J, Milojkovic D, et al. A British Society for Haematology guideline on the diagnosis and management of chronic myeloid leukaemia. Br J Haematol. 2020 Oct;191(2):17c
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